Management of Renal Artery-Inferior Vena Cava Fistula Following Nephrectomy for Penetrating Trauma

Background: Renal artery to inferior vena cava fistula is a rare event postnephrectomy. We report a case of an adult male in whom a renal artery to inferior vena cava fistula was detected on non-invasive studies following nephrectomy for penetrating trauma. Case Report: A fistula between the right renal artery and inferior vena cava was confirmed with diagnostic angiography. The fistula was successfully embolized using microcoils. Discussion: This case highlights the importance of exploring retroperitoneal hematomas secondary to penetrating trauma.

Endovascular Rescue for Renal Artery Pseudoaneurysms following Minimally Invasive Robot-Assisted Partial Nephrectomy—A Case Series

Nephron sparing surgery or partial nephrectomy has been employed ever since in cases of renal tumors with an aim to preserve the function of residual kidney. Lately, there has been increasing adoption in robot-assisted techniques for partial nephrectomy. However, renal surgeries of any kind have always been a hazard for postoperative vascular complications owing to high vascularity of the renal tissues, of which renal artery pseudoaneurysm is one of the most fatal complications. We present a case series where highly super-selective embolization rescues the patient and augments the nephron sparing nature of the precise robot-assisted partial nephrectomy.

Sex differences in rat renal arterial responses following exercise training

During aerobic exercise, hemodynamic alterations occure; while blood flow in skeletal muscle arteries increases, it decreases in visceral vessels due to mesenterial vasoconstriction. However, maintaining renal blood flow during intensive sport is also a priority. Our aim was to investigate the changes of vascular reactivity and histology of isolated renal artery of male and female rats in response to swim-training. Wistar rats were distributed into four groups: male sedentary (MSed), male trained (MTr), female sedentary (FSed), and female trained (FTr). Trained animals underwent a 12-week-long intensive swimming program. Vascular function of isolated renal artery segments was examined by wire myography. Phenylephrine-induced contraction was lower in FSed compared to MSed animals, and it was decreased by training in male but not in female animals. Inhibition of cyclooxygenases by indomethacin reduced contraction in both sedentary groups, and in MTr but not in FTr animals. Inhibition of nitric oxide production increased contraction in both trained groups. Acetylcholine induced relaxation was similar in all experimental groups showing predominant NO-dependency. Elastin and smooth muscle cell actin density was reduced in female rats after aerobic training. This study shows that, as a result of 12-weeks-long training, there are sex differences in renal arterial responses following exercise training. Swimming moderates renal artery vasoconstriction in male animals, while it depresses elastic fiber and smooth muscle actin density in females.

Endovascular Treatment of Renal Artery Thrombosis in Living-Donor Kidney Transplant Recipient With Severe COVID-19 Disease

Purpose: Coronavirus disease 2019 (COVID-19) patients have a higher prevalence of micro-and macrovascular thrombotic events. However, the underlying mechanism for the increased thrombotic risk is not completely understood. Solid organ transplant recipients infected with SARS-CoV-2 may have an exponential increase in thrombotic risk and the best management strategy is unknown. Case Report: A female kidney transplant recipient presented with allograft’s renal artery thrombosis after a recent COVID-19 infection. Due to the risk of kidney failure or exclusion, catheter directed thrombolysis was performed. Residual thrombus was excluded using an endoprosthesis with an excellent result. There were no adverse events and kidney function improved. Conclusion: This paper reports the endovascular treatment of renal artery thrombosis in a living-donor kidney transplant recipient with severe COVID-19 disease.

The value of inflow inversion recovery MRI for the diagnosis of transplant renal artery stenosis: comparison with digital subtraction angiography

Background To date, few data on the assessment of transplant renal artery stenosis (TRAS) by using inflow inversion recovery (IFIR) are available. The aims of this study was to evaluate the feasibility of IFIR in the assessment of TRAS using Digital Subtraction Angiography (DSA) as the reference. Results We retrospectively assessed the IFIR of 195 transplant renal arteries. The IFIR images for 194/195 arteries were judged to be of excellent, good, or moderate quality, and 1/195 was not diagnostic. There were 100 arteries with TRAS, of which 27 were subjected to DSA. The stenosis percentages were divided into five grades. Using DSA images, the TRAS in 27 patients were estimated as grade 1 (2, 7.4%), grade 2 (8, 29.6%), grade 3 (10, 37.0%), grade 4 (7, 25.9%) and grade 5 (0, 0%). In comparison, the TRAS was shown to be grade 1 (1, 3.7%), grade 2 (8, 29.6%), grade 3 (9, 33.3%), grade 4 (9, 33%) and grade 5 (0, 0%) in the IFIR images. The nonparametric Wilcoxon signed-rank test was used to compare IFIR with DSA. In addition, a Bland–Altman plot was used to estimate the agreement between IFIR and DSA measurements. There was no significant difference between IFIR and DSA measurements (p < 0.05). Conclusions Relative to the reference DSA, IFIR was shown to be noninvasive, accurate for the diagnosis and evaluation of TRAS.

3D-Printed Cold Preservation Device in Renal Autotransplantation for the Treatment of a Patient With Renal Artery Stenosis

Percutaneous transluminal angioplasty (PTRA) is a common treatment method for renal vascular disease (RVD). However, PTRA may not be effective in patients with abnormal vascular disease. Renal autotransplantation (RAT) has been used as an alternative therapy for these diseases. Restrictions due to intracorporeal kidney cold preservation and the renal function of intracorporeal RAT were not as well protected compared with open operation. We developed this technique of 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT for the purpose of better protecting the renal function and determining the feasibility of this novel procedure. The procedure was successfully applied to a 51-year-old woman with bilateral renal artery stenosis. The operation time was 5 hours, and blood loss was 200 ml. The patient’s blood pressure remained constant throughout the operation, and the pressure was maintained at 120-140/70–90 mmHg without antihypertensive drugs 1 week after the operation. B-ultrasound showed that the blood flow signal of the transplanted kidney was normal and the boundary between the skin and medulla was clear. The patient was discharged 2 weeks after surgery. One year postoperatively, Doppler ultrasound of the autotransplant showed that the transplanted kidney was normal in size and shape. Radionuclide renal dynamic imaging revealed that the glomerular filtration rate (GFR) of the transplanted kidney was 36.9 ml/min. 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT are a safe and effective method for the treatment of renal artery stenosis and represent a feasible method for preserving the renal function of severe renal artery stenosis patients; however, the technology is still at the exploratory stage and has room for further improvements.